Vincent Van Gogh is one of the most celebrated creative artists of all time. All his life, he was afflicted by some kind of neurological or psychiatric disorder, which remains a mystery even today. Many historians and his personal physicians believe that he suffered from epilepsy while others felt that he was affected by Ménière's disease. Features such as hypergraphia, atypical sexuality, and viscosity of thinking suggest the possibility of Gastaut-Geschwind phenomenon, a known complication of complex partial seizure. On the contrary, some historians feel that he was forced to sever his right ear in order to get relief from troublesome tinnitus, a complication of Ménière's disease. He was addicted to the liquor absinthe, which is known to lead to xanthopsia, and many authorities argue that this was the reason for his penchant for the deep and bright yellow color in many of his paintings. Others have suggested the possibility of bipolar disorder, sunstroke, acute intermittent porphyria, and digitalis toxicity as well.

Keywords: Absinthe, epilepsy, Ménière′s disease, Vincent Van Gogh

How to cite this article:Bhattacharyya KB, Rai S. The neuropsychiatric ailment of Vincent Van Gogh. Ann Indian Acad Neurol 2015;18:6-9

There can be no gainsaying that Vincent Van Gogh is one of the most gifted creative artists of all time. Such was his intensity, it may appear that he was consumed by his own passion. However, the disease that afflicted and troubled him almost all his life still remains a mystery.

Van Gogh was born in a village named Groot-Zundert in Holland on March 30, 1853. In a letter to his younger brother Theo with whom he had a deep and enduring relationship, he once wrote, "My youth was gloomy, cold and sterile". [1] After peregrinations in different countries in Europe and dabbling in various assignments, his serious interest in art grew while he was in Paris, and in 1887, he befriended Paul Gauguin, the renowned post-impressionist artist, and a life-long camaraderie grew between them. In 1888, he moved to Arles in southern France and in the next year, volunteered himself for hospitalization in Saint-Rémy, a province in France where Théophile Peyron, a physician treated him. During his stay there, he painted his immortal, The Starry Night and others. [2] He left the clinic in 1890 and moved to Auvers-sur-Oise, a commune in Paris, where he was treated by Paul Gachet, and later he sought refuge in the company of Theo. In the same year, he painted two of his most haunting works, The Irises and Wheat Field with Crows; the former being sold at a record 53.9 million US dollars in 1987 and the latter often cited as his last work. Soon he was terminally ill and was unable to write though he continued to paint and draw with unabated zeal. A few months later, he presumably shot himself though no gun could be found in his vicinity, and Steven Naifeh and Gregory White Smith, Van Gogh's biographers, argue that he was accidentally shot by two boys who had been handling a malfunctioning gun. [3],[4] He reeled back to his home and was attended by two physicians who however failed to remove the bullet from his body. He was left alone and was found smoking his pipe. Theo rushed toward him the following morning but van Gogh breathed his last the same evening on the July 29, 1890. [5],[6] Thus, he was finally put out of his interminable pains and his troubled and tortured life.

His Illness

There is no unanimous agreement on Van Gogh's incapacitating illness. Historians and researchers have variously felt that he might have had suffered from epilepsy, bipolar disorder, sunstroke, acute intermittent porphyria, lead poisoning, absinthe intoxication, Ménière's disease, and digitalis toxicity. The symptoms were poor digestion, regular stomach upsets, hallucinations, nightmares, stupor, absent-mindedness, anxiety, insomnia, and impotence. [7] These symptoms were described in many of Van Gogh's letters and documents, such as the asylum register at Saint-Rémy. He suffered from seizures, and during one such attack in December 1888, he indulged in self-mutilation and snipped off a part of his right ear. He was admitted to a hospital in Arles where he was diagnosed to be suffering from acute mania with generalized delirium. [8] However, the story also goes that the ear was actually severed with a rapier by Paul Gauguin - the celebrated French artist and Van Gogh's close mate - during a quarrel and Van Gogh presented the detached pinna to a prostitute in a nearby brothel. Felix Ray, a young intern in that hospital, felt that he had been suffering from a condition he termed 'mental epilepsy'. [4] These attacks were increased in frequency by 1890, the longest and the severest phase lasting for nine weeks from February to April 1890.

Most of the contemporary physicians, friends, and observers felt that Van Gogh suffered from epilepsy and he himself thought as much. Félix Ray, his physician at the Old Hospital, Arles, was of such opinion and Théophile Peyron at St Rémy felt the same way. [9],[10] On January 29, 1889, Peyron wrote a letter to Theo. The following is an excerpt from that letter,

'I am writing to you on behalf of M. Vincent, who is the victim of another attack… M. Vincent was getting on very well and was completely himself when last week he wanted to go to Arles to see some people, and two days after he made the journey the attack took place. At present his is unable to do any work at all and only replies incoherently to any question put to him. I trust that this will pass again as it has done before.'

Edgar Leroy and Victor Doiteau, his biographers, advanced the diagnosis of temporal lobe epilepsy in 1928 and it was generally accepted among physicians of that time. [11] Others indicated that the nature of Van Gogh's seizures and the time and duration of the episodes did not follow the pattern of classical complex partial seizure and the therapeutic response to bromide possibly refuted the diagnosis and indicated grand mal seizure, as the condition was known in good old days. Additionally, some authorities feel that Van Gogh displayed some of the features suggestive of Gastaut-Geschwind syndrome, including hypergraphia, hyperreligiosity, atypical sexuality, circumstantiality, viscosity of thinking, and intense mental attitude. [12],[13] Michael Trimble, the noted behavioral neurologist from Queen Square, London, wrote that Van Gogh communicated in more than 600 letters to Theo and others in his short life, and during 1884-1886 while he was in Nuenen, he finished 225 drawings, 25 water colors, and 185 oil paintings. Thereafter, from 1886 to 1888, when he was in Paris he completed 200 oil paintings, 40 drawings, and 10 water colors. This massive outpouring of creativity went on unabated in the last two years of his life at Arles. Some observers have alluded to the near-repetitive and seemingly compulsive nature of the themes in his writings, some of which might even seem quasi-religious. [14] HA Voskull in his article, Van Gogh's Disease in the Light of His Correspondence, is of the same opinion while Bhattacharyya in his book, Eminent Neuroscientists: Their Lives and Works, hinted at the same issue as well. [15],[16]

It is on record that Van Gogh suffered from hallucinations and nightmares for a long time, and on occasions, he slumped into a stuporose state. [9],[10],[11] He mentioned about his impotence to his brother, Theo, and was virtually obsessed with it since he wrote on the same issue to his friend Bernard, a month later. [12] He mentioned and contemplated about committing suicide on several occasions, though Steven Naifeh and Gregory White Smith drew attention to his moral compunction against such an act. [4] He was an inveterate drinker and his habit of incessant smoking and coffee drinking, coupled with his aversion towards food and occasional fasting largely contributed towards his declining health. He was seen with a pipe dangling from his lips even in his deathbed, and in general, it is believed that all these vices resulted in malnutrition. [13] There is some evidence to suggest that he used to nibble at his paints, often referred to as pica, and some historians have attributed this habit to the genesis of seizures around 1890. Theo once wrote to him, "if you know that it is dangerous for you to have colours near you, why don't you clear them away for a time, and make drawings?"[14]

Van Gogh might have had suffered from bipolar disorder since he had been exhibiting phases of intense activity followed by periods of extreme exhaustion and depression. [17] Thujone intoxication, resulting from his life-long addiction toward absinthe has been put forward as another hypothesis. [18] Roch Grey, a physician, felt strongly that he suffered from some form of chronic sunstroke [19] and Van Gogh himself, while in Arles, once wrote in a letter to Theo stating, "Oh! that beautiful midsummer sun here. It beats down on one's head, and I haven't the slightest doubt that it makes one crazy.' Later, he wrote to his brother, 'Many thanks for your letter, which gave me great pleasure, arriving just exactly at the moment when I was still dazed with the sun and the strain of wrestling with a rather big canvas".[20]

That Van Gogh suffered from Ménière's disease has been a subject of serious speculation for a long time. Yasuda first adduced the hypothesis in 1979 [21] and Arenberg et al., after analyzing Van Gogh's 796 letters, endorsed this view in an article in the Journal of American Medical Association in 1990. [22] Symptoms such as nausea and vomiting from which he suffered perpetually and the severing his own right ear, presumably in order to relieve the troublesome symptoms of tinnitus are the arguments often advanced in favor of the diagnosis. Though Prosper Ménière described the disease in 1861, two years before Van Gogh was born, it is likely that the condition was still not well known among physicians at that time and those who attended him could not identify his illness. However, this view has been piquantly challenged by Martin in a recent publication. [23]

In his doctoral thesis submitted in 1991, Gonzalez Luque argued that Van Gogh might have had suffered from chronic lead intoxication since lead pigments constituted an important component in the colors he used. Symptoms such as stomatitis, abdominal pain, anemia, signs of lead neuropathy, and other features of lead encephalopathy along with delirium and epileptic fits strongly indicate lead as an incriminating factor. [24] It has been seen that painters exposed to colors often succumb to lead poisoning, and importantly, recent researches conducted on toxic lead pigments attest the diagnosis of saturnine poisoning in Van Gogh. [25] Acute intermittent porphyria is another condition often thought of as the chief malady that he suffered from, and Arnold gave a detailed description in the Journal of Historical Sciences in 2004. [26] However, there are arguments to the contrary since the most important finding of reddish discoloration of urine on standing was conspicuously absent and the pain of gastritis did not resemble the severe abdominal colic that is characteristic of this condition. Moreover, no member in his family suffered even remotely from such a condition and the majority of historians are therefore reluctant to accept this view. On the other hand, speculation is rife that both Van Gogh and Theo were victims of syphilis and the view was first put forward by Cavenaille, a physician, though others who had been looking after them for a long time, such as Rey and Peyron, did not subscribe to such a view. Later researches seem to rule out that his mental symptoms could be attributed to general paresis of the insane. [27] Furthermore, even if it can reasonable be assumed that the kind of life they spent in Paris from 1886 to 1888 was not truly rigid and virtuous, the long time to develop symptoms of neurosyphilis was not truly met in their lives and physicians such as Rey, Peyron, or Gachet, who knew them from close quarters for a long time, dismissed the idea summarily.

Alternatively, some historians suspect that Van Gogh was a victim of consumption of the deadly liquor absinthe for a very long time [28],[29] and his penchant for the deep and bright yellow color in most of his paintings, such as Wheat Field with Crows, The Night Café, Les Alyscamps, and Sunflower, raise serious questions about xanthopsia or the yellow halo, a known complication of absinthe intoxication in the genesis of his neuropsychiatric ailments. [30] Jean-Pascal Gastaut, the famous French neurologist, recognized the crucial role of absinthe in the manifestation of Van Gogh's major psychiatric symptoms. [31] However, later researches showed that one needs to consume virtually gallons of this alcoholic beverage in order to develop xanthopsia and that amount seems most unlikely for even Van Gogh to drink in his lifetime. [32]

In this context, it would not be out of place to record what Barnaby felt about this alcoholic beverage,

"Absinthe makes you crazy and criminal, provokesepilepsyandtuberculosis, and has killed thousands of French people. It makes a ferocious beast of man, a martyr of woman, and a degenerate of the infant, it disorganizes and ruins the family and menaces the future of the country."[33]

It has been suggested that oil of wormwood obtained from the plant Artemisia absinthium is one of the most toxic principles in absinthe. It contains the terpene compound thujone, structurally an isomer of camphor, which induces convulsion. Both thujone and camphor induce convulsions, and they were used liberally during the 1920s and 1930s in the study of models for epilepsy. Ladislas von Meduna, the noted Hungarian psychologist, in the first half of the 20 th century, used thujone for the convulsive therapy of schizophrenia [34],[35] and in 1873, Valentin Magnan, the famed psychiatrist from France, described what he termed épilepsieabsinthique. Later textbooks on neurology referred to the relationship of absinthe and epilepsy, [36] and in the early part of the 20 th century, absinthe was finally outlawed in most countries because of its psychotoxic effects. [37]

It is of some historical interest to note that Van Gogh was prescribed digitalis for his epileptic convulsions. Digitalis, like absinthe, leads to xanthopsia and coronas or glowing haloes around objects, and it is often felt that this might have contributed towards his almost obsessive attraction for the deep yellow color, which permeated almost all his works. [38] This speculation has been further bolstered by the fact that Van Gogh conceived a portrait of his physician Paul-Ferdinand Gachet, where it can vividly be seen that Gachet was holding leaves of Digitalis purpurea. [39]

Concluding Remarks

In spite of the incontrovertible evidence that Van Gogh must have had suffered from some intractable neurological or psychiatric disorder, the precise nature of it is yet unresolved. The body of documents hint at epilepsy, Ménière's disease, and chronic absinthe intoxication as the three most possible conditions, though there are florid arguments to the contrary as well. His short life is shrouded in such mystery, wrapped in an enigma that even his nature of death remains a matter of conjecture - whether he shot himself or whether he died accidentally. It is hoped that future historians shall be able to unearth other facets in the life of this tortured genius, and we shall be further enriched [Figure 1].

Figure 1: Three of Van Gogh's immortal paintings- The Wheatfield With the Crows (a), Les Alyscamps (b), Sunflowers (c). One marvels at the intensity of the yellow colour, the bold strokes and the speckled coronas that permeate most of his paintings